Years ago over lunch, a close young female friend of mine who had been married only a short while asked me if having sexual intimacy twice a week was “normal,” or in other words, comparable to the number of times weekly my husband and I made love. I gathered that she was trying to gain some idea of what frequency of sexual relations other couples had, so that she would have a benchmark by which to measure the health of her own sex life with her husband. Although I did divulge to her the average frequency of my own sexual activity with my husband (since she was a close and trusted friend), I also explained to her that the best measure of the health of any woman’s sex life is not the comparative frequency she and her partner have sex in relation to other couples, but rather the balance between her sexual desire and that of her partner. There are two and only two significant participants (at least, one would hope!) in a couple’s life both in and out of the bedroom, and what contributes most to the “normalcy” of their sex life is the amount of satisfaction and fulfillment they are both experiencing with their love-making and sexual union in general. It takes two satisfied partners to constitute a good sex life, which is built upon the levels of desire and satisfaction which each individual possesses. I also explained to her what my mother once told me, that men’s brains are wired to be more preoccupied with intercourse than the female brain, and that they need it more on a purely physical level than we as women do. Thus, the balance of desire may sometimes appear to be skewed, and a woman may begin to feel that she is abnormal simply because her mind is not on sex as much as is her partner’s (and an insensitive husband may sometimes blurt out this opinion in the heat of the moment). I explained to her that while this discrepancy is really normal rather than abnormal, that we as women needed to work at bridging that gap and finding ways to enter a man’s mental and sexual world while at the same time inviting him to visit ours. Thus what really matters is coming closer to understanding and accommodating one another’s sexual needs, and finding common ground in order to gain a balance in satisfaction. It just will not do to have one partner jacked up all the time, feeling short-changed and resentful, with the other partner feeling put-upon and pressured to perform. That would be like when as a child I sat on a see-saw on the playground, with a much heavier child on the other end. Try as I might, we couldn’t get the see-saw to balance or to go back and forth, and I usually ended up having to jump off and hit the ground hard! But as long as a sort of loving compromise can be reached which allows both partners to have their felt needs met, a state of balance has been achieved which is irrelevant to the number of times a week they actually have sex. In short, I told her that sexual balance superceded sexual frequency in importance! But I’m also here to tell you that there are lifestyle changes which, when adopted by both partners, can help both you to desire and enjoy sex more frequently and more passionately.

If you are experiencing an almost total loss of sexual desire or have pain during sex, this constitutes a sexual dysfunction. In order to qualify as a real sexual dysfunction, one or both partners would be dissatisfied with the state of their sex life, and there would be an imbalance in sexual desire and interest, with one partner’s desire far outweighing that of the other, creating intense unhappiness for one or both partners. Know this, if you have a sexual dysfunction which prevents mutual satisfaction and fulfillment in your relationship, there are definite causes for the dysfunction which, when properly addressed, can restore the sensuality and sizzle to your relationship. First of all, your psychological history contributes to your sexual functionality. No matter how we learned about sex, in the process of learning we picked up more than bare facts – we also picked up emotional, moral, and cultural associations to sex. If your psychological history includes anything with a negative connotation associated with sex, chances are you have retained some of those negative sexual connotations to this day. The key to changing this is honesty, first with yourself and your partner, and then possibly talking about it with a therapist or close friend. If you have positive psychic vibes regarding sex but your physical desire is low, the first positive step towards changing this is to transform your diet and lifestyle to follow healthy guidelines. Improving dietary intake and exercising will improve self-image and help to balance our hormones naturally, which will often improve the libido as well.

If you are eating a healthy diet and exercising regularly and still experiencing low libido, a visit to your gynecologist which includes an honest assessment and a thorough lab work-up is in order. There are many bio-identical hormone treatments today with a variety of routes of administration available. Make sure, however, that the gynecologist with whom you consult is knowledgeable and qualified in the area of hormone therapy. Not just any OB/GYN who claims to specialize in HRT will necessarily be of help for your specific problem, but with some determined research and seeking, you can find the right practitioner to help with your problem.

When a couple’s sexual balance is out of whack, a frequent by-product is resentment, no matter how much they love each other. One all-important deterrent to the forming of resentment is honest communication. Men, you need to know that a lower-than-desired libido in your woman is not to be viewed as a defect, but rather the result of very real physical and psychological causes which, although beyond her control in the past, can be remedied in the future. Ladies, be certain of this, your man is just being a man when he communicates his urgent need for sex, and that with some work on altering psychological attitudes and presuppositions as well as finding medical and non-medical ways to improve your general and sexual health, the two of you can ride that sexual see-saw together (hmm, I just had a vivid mental image of a very kinky sexual encounter involving a see-saw!). No seriously, by paying heed to these real time-tested truths regarding the complicated but beautiful gift of sex, the “see-saw” may go up and down, but a healthy balance will be achieved!

Sexual dysfunction often has deep psychological roots. This is not to say those afflicted by sexual dysfunction are imagining everything; it just means that our beliefs and attitudes truly do affect our reality. There are most certainly physical causes for the disorder as well, since often sexual dysfunction in an individual is caused by several different factors which interact to produce the difficulty. Treating sexual dysfunction is definitely a multi-faceted approach, but understanding the deeply held emotional reactions of a patient toward sex can be the key to unlocking their difficulties in the bedroom.

Sexual dysfunction can often be traced back to a patient’s upbringing. Religion and culture play a very important role in defining who we are as we develop, and those raised in very strict religious families, or in cultures with punitive attitudes toward sex, often suffer from problems related to sexual functioning in adulthood. If we hold a very deep-set belief that what we are doing is wrong or dirty, then how can we possibly find enjoyment in that activity? If sex has always been associated in the mind with deviant behavior or punishment, it will be difficult to engage in sexual activities without a deep sense of guilt and shame – let alone actually enjoy it. For victims of sexual abuse, these beliefs can be particularly hard-wired and damaging. It is important to seek therapy and heal from past events, and learn to accept sex as a loving and nurturing behavior rather than a traumatic and abusive experience.

Treating sexual dysfunction often involves confronting these beliefs and changing attitudes toward sex so that it is viewed in a positive light, as a reflection of the love and intimate bond between a couple. These beliefs can function as an emotional wall in your relationship, separating you both psychologically and physically from your partner. My Sexual CPR course will give you all the tools you need to tear down that wall once and for all, and embark upon a journey of redisovery together as a couple.

Spice up your Sex Life: Herbs that will do the TrickInterviewer: Gail Edgell

Gail Edgell: Could you tell us why a woman’s sex drive varies during her perimenopause and menopausal years?

Dr. Chilkov: The female sex drive, or libido, is very complicated. It’s not about one thing. Certainly, in the context of this interview, I want to talk about exhaustion, adrenal stress and depletion, alongside changes in estrogen. All of these things work together to decrease a woman’s sex drive. The idea is not to use something that will titillate for the evening, but something that will really build sexual health and well-being over time. I am going to talk about things that women can take every day to nourish themselves at a very deep level, so that they still will feel vital sexually. We are going to talk about herbal medicines.

The Chinese associate health and longevity with libido and sex drive. The Chinese talk a lot about nourishing Qi and nourishing essence. Qi (pronounced “chee”) is the Energy of Life that is circulating through all living things. When the smooth and harmonious flow of the Qi is disturbed, or when Qi is depleted, illness and disease arise. Some tonic herbs do that in particular for sexual vitality. These are herbs that are more like concentrated foods; they are not drug-like. It’s like taking a very concentrated kind of vitamin for your sexuality. I am going to talk about a few herbs that are traditionally used in Chinese Medicine for sexual tonics. The first herb is Epimedium.

Epimedium’s common name is “Horny Goat Weed,” which says it all. It was originally discovered by herders who watched the animals eat it and saw that they wanted to have more sexual activity. This is an herb that is used by both men and women. But it’s really one of my favorite herbs for women. It’s really great for osteoporosis and preserving bone density. It’s also a slightly calming herb and will decrease high blood pressure. This herb is what the Chinese call a “yang” tonic. It really, really boosts your energy, and you feel a lot more vibrant.

Gail Edgell: Is it best to take this herb in the morning?

Dr. Chilkov: It’s not a stimulant like caffeine, so it’s not a problem in that way. That is true of all the herbs that we are going to talk about today.

Ginseng is another very famous and well-known herb. I primarily recommend American Ginseng for women because American ginseng nurtures the “yin,” or the feminine moist aspect. It’s also a very potent natural aphrodisiac that elevates hormones and neurotransmitters and increases blood flow to the sexual organ in a way similar to how Viagra works, only milder. Ginseng is great in post-menopausal women because it can prevent the natural atrophy, or shrinking, of some of the vaginal tissues.

Ginseng is one of the most strengthening herbs in terms of a woman’s vital energy, or Qi. It also helps her adapt to stress. A lot of people lose their sex drive, or their libido, because they’re stressed out and exhausted. Nature is wise. If a woman only has a certain amount of energy to spend, Nature will have her conserve it and not spend it on sex, especially if there is not enough to go around. If a woman is feeling lethargic, she wants to nourish her energy. This herb will give her more sexual energy overall.

Both of these herbs, Epimedium and Ginseng, will also work on a deeper layer of the nervous system to allow a woman to be relaxed and excited at the same time. That is much more preferable to being wound up and stimulated.

Ginseng should be used long term, on a daily basis, to really enhance a woman’s sexual vitality. Most of these herbs are not used by themselves; they are typically used in combination with other herbs to increase sexual potency.

Gail Edgell: Will it say “American Ginseng” on the product label?

Dr. Chilkov: Yes. You will see that Ginseng can be labeled as Korean Ginseng, Chinese Ginseng or American Ginseng. Women can use Chinese Ginseng and Korean Ginseng. But American Ginseng is much more balanced for them.

The next herb that I want to talk about is called Cordyceps. This is one of the great shining stars in Chinese Medicine, particularly in terms of aphrodisiacs. I will also say that it is one of the great herbs in cancer care and immune stimulation. But it’s a very powerful sexual stimulant as well. A woman is building her sexuality and her immunity when she uses an herb like this. She will want to take it on a daily basis, combined with Ginseng and Epimedium. Over time, she will feel much, much more vibrant. Cordyceps has been shown to provide significant improvement in the treatment of sexual function. It’s also used in men to treat impotence. It’s very safe, and it increases endurance, vigor and energy. Even athletes use this herb.

There is a fourth herb that I want to talk about that is not a Chinese herb. Maca root is an herb from Peru. It has been used for thousands of years in South America for boosting sexual health, libido and fertility. I have found that when estrogen starts to decline, Maca root is one of the best herbs for giving a woman balance. It helps smooth the menopausal journey. This herb also has a lot of minerals, enzymes and amino acids. These are all very important for normal sexuality and a high libido. It really increases desire.

I want to emphasize that these four herbs that I have mentioned — Epimedium, American Ginseng, Cordyceps and Maca root — are all safe to use. These herbs are widely used in China. Many people over 40 take tonics like these. It’s comparable to taking a multivitamin.

These herbs will reduce menopausal symptoms. They will regulate hormonal irregularities and smooth out the menopausal transition. For women who are still menstruating, it will ease their cycles. These herbs do this by leveling out mood fluctuations and helping with mental acuity, concentration, stamina and vitality. These are not herbs that a woman only wants to use the night before she wants to have sex. These are herbs that need to be used on a daily basis, so that she feels like having sex more often and has the energy to do it.

Gail Edgell: Do you typically take the last one, the Maca root, in combination with the other herbs that you mentioned?

Dr. Chilkov: Each one of these herbs can be taken alone. But the real art of herbal medicine is making balanced formulas. As an herbalist, I find it much more effective and much more balanced, even much more elegant, to make a formula that is tailored for an individual. You will see that if you look at a good natural food store, or if you live in a city where there is a Chinatown, that the formulas are always found in combinations. You can also buy very expensive Ginseng root that is prepared in a very special way.

Note: This article is an edited transcript of an audio interview. Changes have been made.